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General NPI Number Information
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NPI Number | 1659654424
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Entity Type | Organization
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Legal Business Name | A TOUCH OF TRANQUILITY MASSAGE
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 17150 UNIVERSITY AVE SUITE 100
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City | SANDY
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State | OR
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Zip | 97055-9290
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Country | US
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Telephone | 971-409-0949
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Fax | 503-663-0664
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Provider Business Mailing Address
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Address Line | 11943 SE 362ND AVE
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City | BORING
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State | OR
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Zip | 97009-8720
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Country | US
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Telephone | 971-409-0949
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Fax | 503-663-0664
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | ATHENA WRENNETTE ROLPH
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Credential | LMT
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Telephone | 971-409-0949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 18063
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License Number State | OR
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